tbuckley/cabot-search huggingface dataset:
Abstract 11703: A Rare Case of Redo MitraClip Failure Requiring Salvage Mitral Valve Replacement
Authors: Mahati Dasari, Pramukh Arun Kumar, Sumukh Arun Kumar, Anoop Titus, Akil A Sherif, Mark Kranis
Journal: Circulation (2022)

Presentation: A 74-year-old lady with history of hypertension, COPD, severe pulmonary hypertension, HFpEF, redo MitraClip placement for severe mitral regurgitation (MR) secondary to mitral valve (MV) prolapse presented with four months of progressive dyspnea and bilateral lower extremity swelling. Vitals were significant for hypotension and tachycardia. Examination revealed a holosystolic murmur at the apex, crackles in bibasilar lung fields, and 3+ bilateral pitting pedal edema. Work-up: TTE revealed EF of 65%, enlarged right ventricle, flattened interventricular septum, multiple mitral clips attached to the MV leaflets, and an eccentric MR jet. TEE revealed severe left atrial dilation, severe MR with eccentric and posteriorly directed regurgitant jet and mal-coaptation of MV leaflets with three MitraClips attached (Figure 1-3). Management: For recurrent severe mitral regurgitation resulting in decompensated heart failure, options included another redo MitraClip procedure versus surgical MV replacement. After extensive discussion with the multidisciplinary team and the patient, a decision was made to proceed with surgical MV replacement accepting a high operative risk with STS risk score of &gt;8%. Intraoperative findings revealed one inverted MitraClip with posterior leaflet detachment and two other clips that had densely scarred into the posterior leaflet leaving an unrecognizable MV (Figure 4). A 29 mm Epic Plus bioprosthetic MV was placed successfully. After a prolonged postoperative course, her clinical status improved. Conclusion: In patients who have failed the MitraClip procedure, significant destruction and fibrosis of the leaflets leaves surgical MV replacement being the only reasonable option. Surgical risk must be determined in conjunction with a multidisciplinary team as MV repair is performed at advanced centers in high-risk patients with good results. This can reduce the number of redo MitraClip and salvage MV surgery.
Abstract 12084: Premorbid Physical Activity and Prognosis After Incident Myocardial Infarction: The Atherosclerosis Risk in Communities (ARIC) Study
Authors: Yejin Mok, Yifei Lu, Shoshana Ballew, Yingying Sang, Anna Kucharska-Newton, Silvia Koton, Jennifer Schrack, Priya Palta, Josef Coresh, Wayne D Rosamond, Kuni Matsushita
Journal: Circulation (2022)

Introduction: Physical activity (PA) is associated with a reduced risk of mortality and cardiovascular disease in the general population. However, it is unclear whether PA level in midlife impacts prognosis after myocardial infarction (MI) in later life. Methods: In 1,115 ARIC participants with incident non-fatal MI during ARIC follow-up (mean age 73 [SD 9] years at MI, 54% men, 21% Black), PA prior to incident MI (premorbid PA) was evaluated at visit 1 (1987-89) and visit 3 (1993-95) using a modified Baecke questionnaire; we studied the cumulative PA index scores across these two visits. Total and domain-specific PA (sport, leisure time, and work PA) were analyzed for their associations with mortality, recurrent MI, stroke, and heart failure after MI using multivariable Cox models. Elapsed time between visit 3 and incident MI was on average 11.9 (SD 6.9) years. Results: During a median follow-up of 2.0 [IQI 0.03-8.0] years after incident MI, 914 participants (82%) developed a composite outcome. The 8-year cumulative incidence of composite outcome was lower in the highest tertile of premorbid total PA than the lowest tertile (62% vs. 72%, respectively) ( Figure ). When adjusting for MI risk factors, the association was not significant. However, for individual outcomes, higher premorbid total PA was associated with a lower risk of recurrent MI (adjusted hazard ratio [HR] 0.66 [95% CI 0.45, 0.96] for the highest vs. lowest tertile). Results were similar for sport and work PA but not leisure time PA. When we focused on short-term prognosis within one year after MI, both higher total PA and sport PA were associated with lower mortality (HR 0.62 [95% CI 0.43, 0.90] and 0.62 [0.44, 0.89], respectively). Conclusions: Greater premorbid PA was associated with better prognosis after MI occurrence, both short-term and long-term post-MI. Our results demonstrate additional prognostic advantage of PA beyond reducing the risk of incident MI.
Abstract 11069: Evaluation for Ischemic Cardiomyopathy After Heart Failure Diagnosis is Associated With Reduced Mortality in a Safety-Net Setting
Authors: Matthew S Durstenfeld, Anjali Thakkar, Yifei Ma, Lucas Zier, Jonathan D Davis, Priscilla Hsue
Journal: Circulation (2022)

Introduction: Ischemic cardiomyopathy is a common cause of heart failure (HF). Many commercially insured HF patients are not evaluated for ischemia, but rates of testing in a safety net setting have not been investigated, and the effect of testing on mortality is not clear. Methods: We developed an EHR cohort of individuals with HF by ICD9 or 10 code in San Francisco’s municipal health system during 2001-2019. Invasive coronary angiography, nuclear stress, and coronary CT angiography were considered as ischemic testing. Proportions tested and adjusted relative risks [ARR] for testing were adjusted for age, sex, diabetes, hypertension, and tobacco use. To estimate the effect of testing on mortality, we created a “target trial” of patients with incident HF without known CAD using propensity score models. Results: Out of 15,558 individuals with HF, 4,215 (27.1%) ever underwent ischemic testing, without increase over time (p=0.33). Excluding those with prior testing, 2,483/13,821 (18.0%) had testing at a median 25 days after HF diagnosis (IQR 0-417). Groups less likely to receive testing included women (ARR 0.89, 95%CI 0.82-0.96; p=0.003), unstably housed individuals (ARR 0.45, 95%CI 0.37 to 0.54, p&lt;0.0001), people with HIV (ARR 0.67, 95%CI 0.57-0.79, p&lt;0.0001), and methamphetamine users (ARR 0.77, 95%CI 0.69-0.86; p&lt;0.0001). Those hospitalized for HF were more likely to be tested (ARR 2.21, 95% CI 2.05-2.39; p&lt;0.0001). Testing within 30 days was associated with a 4% absolute reduction in mortality (95%CI -6.5 to -1.6%; p&lt;0.001) independent of hospitalization. Testing within 30 days and ever were associated with 22% and 27% lower mortality hazard, respectively (Figure). Conclusions: In a municipal health system in San Francisco, women, people with HIV, without stable housing, and methamphetamine users were less likely to receive ischemic testing. Ischemic testing was associated with improved survival. Ischemic testing should be considered for everyone with HF.
Abstract 11850: Association Between SGLT2 Inhibitor Use and Risk of Clinical Events in Patients With Antineoplastic Therapy Associated Cardiomyopathy and Heart Failure
Authors: Vennela Avula, Garima Sharma, Mikhail N Kosiborod, Muthiah Vaduganathan, Tomas G Neilan, Teresa Lopez-Fernandez, Susan F Dent, Lauren A Baldassarre, Marielle Scherrer-Crosbie, Marielle Scherrer-crosbie, Ana Barac, Jennifer Liu, Anita M Deswal, Eric H Yang, Bonnie Ky, Daniel Lenihan, Daniel Lenihan, Anju Nohria, Anju Nohria, Sourbha Dani, Sarju Ganatra
Journal: Circulation (2022)

Background: Antineoplastic therapies can be cardiotoxic and increase the risk of cardiomyopathy and heart failure (HF). SGLT2i are shown to be efficaceous in patients across the spectrums of HF regardless of ejection fraction and presence of type 2 diabetes. However, the impact of these agents on outcomes in patients with antineoplastic therapy associated cardiomyopathy and HF has not been well established. Methods: A retrospective cohort analysis was performed on de-identified, aggregate patient data from the TriNetX research network. Patients ≥18 years of age with a history of exposure to potentially cardiotoxic antineoplastic therapy between Jan 1, 2013 and Apr 30, 2020 who subsequently developed cardiomyopathy or HF and treated with guideline directed medical therapy (GDMT) were identified. Patients with ischemic heart disease were excluded. Patients were divided into two groups based on SGLT2i use. Propensity score matching was performed to match the baseline characteristics. Odds ratio and log-rank test were used to compare the outcomes over a 2-year follow-up period. Results: In well matched cohorts (640 patients in each cohort with antineoplastic therapy associated cardiomyopathy/HF; mean age 67.6 years, women 41.6%, White 68%), patients on SGLT2i in addition to conventional GDMT faced lower risk of acute HF exacerbation (85 vs 154, OR 0.48, 95% CI: 0.36 - 0.65, p&lt;0.001) and all-cause mortality (73 vs 194, OR 0.30, 95% CI: 0.22 - 0.40, p=0.001). Secondary outcomes of all-cause hospitalization or ER visit (OR 0.479, 95% CI: 0.383-0.599, p&lt;0.001), atrial fibrillation/flutter (OR 0.397, 95% CI: 0.213-0.737, p=0.003), acute kidney injury (OR 0.486, 95% CI: 0.382-0.619, p&lt;0.001), and renal replacement therapy (OR 0.398, 95% CI: 0.189-0.839, p=0.012) were also less frequent in patients on SGLT2i. Conclusions: SGLT2i use is associated with lower risk of clinical events in patients with antineoplastic therapy associated cardiomyopathy or HF.
Abstract 12098: Contemporary Trends in Utilization and Outcomes of Percutaneous Left Atrial Appendage Occlusion in the United States
Authors: Mohak Gupta, Vardhmaan Jain, Abdul M Minhas
Journal: Circulation (2022)

Background: Percutaneous left atrial appendage occlusion (pLAAO) is an alternative stroke prevention strategy in patients with atrial fibrillation who are poor candidates for long-term anticoagulation. Methods: We used the National Inpatient Sample to identify adult hospitalizations of patients who underwent pLAAO from 2016 to 2019. Outcomes of interest included peri-procedural complications, in-hospital death, and length of stay (LOS). Major adverse events were defined as a composite of in-hospital mortality, cardiac arrest, new pacemaker implantation, cardiac tamponade, bleeding requiring transfusion, stroke/TIA, AKI requiring dialysis, and systemic embolization. Trends in outcomes were examined using linear regression for continuous variables and binary logistic regression for categorical variables. Results: We found a total of 61090 pLAAO procedures (mean age 76.1 years, 41.7% female, 88.3% at urban teaching hospitals)— 5305 procedures in 2016, 11125 in 2017, 17885 in 2018, and 26775 in 2019. As compared to 2016-2017, patients in 2018-2019 were older (75.7 vs 76.3 years; p&lt;0.01) and more comorbid (Elixhauser comorbidity index of ≥5 in 38.4% vs 41.4%; p=0.01). Major adverse events occurred in 2.4%, and decreased from 2.8% in 2016 to 2.1% in 2019 (p=0.04); primarily driven by a decrease in systemic embolization and stroke/TIA. Overall in-hospital mortality was 0.15%, and decreased from 0.28% in 2016 to 0.15% in 2019 but statistical significance was not achieved (p=0.15). Mean LOS decreased from 1.5 days in 2016 to 1.3 days in 2019 (p&lt;0.01) suggesting that more single-day admissions occurred. Conclusion: There was a 400% increase in the annual volume of pLAAO from 2016 to 2019 signifying a large eligible patient population and increasing assimilation of pLAAO into clinical practice. Most complications decreased despite an older and more comorbid patient population which might be explained by improving operator technique and procedural protocols.
Abstract 11288: Conduction Velocity is Slower in Corridors Traversing Lipomatous Metaplasia Than in Corridors Traversing Scar in Chronic Infarcts
Authors: Lingyu Xu, Sohail Zahid, MirMilad Pourmousavi Khoshknab, Juwann Moss, Ronald D Berger, Jonathan Chrispin, David J Callans, Francis E Marchlinski, Stefan Zimmerman, Yuchi Han, Benoit Desjardins, Natalia Trayanova, Saman Nazarian
Journal: Circulation (2022)

Introduction: We sought to examine the association of infarct scar versus lipomatous metaplasia (LM) with impulse conduction velocity (CV) in putative ventricular tachycardia (VT) corridors that traverse the infarct zone in patients with prior myocardial infarction (MI). Methods: The cohort included 31 patients from the prospective In tra-Myocardial F at Deposition and Ventricular Tachycardia in Ischemic Card i omyopa t h y (INFINITY) study. CV was calculated as the mean CV between that point and five adjacent points along the activation wavefront using an automated Python script in myocardial scar, border zone (BZ), and potential viable corridors defined by late gadolinium enhancement (LGE)-cardiac magnetic resonance (CMR), and LM identified by computed tomography (CT). Both image sets were registered with electroanatomic maps (EAM). Results: Regions with LM exhibited lower myocardial CV than scar (median 12.0 vs. 13.5 cm/s, P &lt;0.001). Of 96 corridors computed from LGE-CMR and electrophysiologically confirmed to participate in VT reentry, 95 traversed through or near LM identified on CT. These critical corridors displayed slower CV {median 8.8 [interquartile range (IQR) 6.0, 15.4] vs. 39.0 (IQR 27.8, 56.5) cm/s, P &lt;0.001, Figure 1}, and demonstrated low-peripheral-high-center (mountain-shaped, 25%), or mean low level (45.7%) CV patterns, when compared to 122 non-critical corridors distant from LM that displayed high-peripheral-low-center (valley-shaped, 20.5%) or mean high level (59%) CV patterns. Conclusion: Myocardial LM is a crucial contributor to VT propensity. Corridors traversing through or near LM exhibit significantly slower CV, which likely facilitate the presence and stability of the VT circuit reentry.
Abstract 12132: Utility of a Proteomic Surrogate for Cardiovascular Outcomes to Predict and Monitor COVID-19 Induced Myocarditis
Authors: Clare Paterson, Michael A Hinterberg, Andrew J Morrow, Robert Sykes, Kenneth Mangion, Paul Welsh, Alex McConnachie, Naveed Sattar, Colin Berry, Stephen A Williams
Journal: Circulation (2022)

Introduction: Poorer cardiovascular (CV) health is a risk factor for adverse outcomes from COVID-19, and a proportion of COVID-19 survivors exhibit CV dysfunction including myocardial inflammation after initial recovery. However, biomarker-driven predictors of CV outcomes in COVID-19 are lacking. We recently demonstrated that a proteomic surrogate of CV outcomes (MI, stroke, hospitalization for heart failure, or death within 4 years) is highly predictive of acute COVID-19 severity. The current study expands on this to determine if a proteomic CV risk test associates with myocarditis likelihood in COVID-19 survivors. Methods: The SomaScan® platform was used for plasma proteomic phenotyping in CISCO-19 trial participants (n=154, mean age 55y, 43% Female) at hospital discharge following COVID-19, and at follow-up within 6-months later when comprehensive CV assessment including cardiac MRI for myocarditis adjudication was performed. N=20 (13%) were classified as very likely to have myocarditis at follow-up. We used linear mixed models to test proteomic CV scores at both visits against myocarditis likelihood across COVID-19 recovery and compared the predictive performance of the CV risk score to discriminate myocarditis likelihood to performance of Troponin I (TnI) and NT-proBNP. Results: A 36% relative CV risk reduction was observed during COVID-19 recovery. CV risk scores were significantly higher among those very likely myocarditis positive at follow up (p &lt; 0.05 for effects) ( Figure 1 ). Additionally, the performance of the CV risk test in classifying myocarditis likelihood at follow-up was superior to that of TnI or NT-proBNP (AUC=0.64 vs 0.52 and 0.51, respectively). Conclusions: A proteomic predictor of CV risk has potential to support cardiac screening and monitoring CV health across the course of COVID-19 recovery, with diagnostic specificity superior to that of specific single cardiac biomarkers. Future studies with this approach seem warranted.
Abstract 12562: To Call ‘911’ or Not: What Influences Decision Making in Patients With St-Elevation Myocardial Infarction (STEMI)?
Authors: Lorraine Avery, Kirsten Marshall, David Nelson, Yixiu Liu, Robert Grierson, Shuangbo Liu, John Ducas
Journal: Circulation (2022)

Introduction: It is well-established that total ischemic time (TT) is related to mortality of STEMI patients treated with primary percutaneous coronary intervention (PPCI). TT is composed of the time from symptom onset (Sx) to first medical contact (FMC) and FMC to device. Shortest times are achieved when patients decide to call ‘911’, have a pre-hospital electrocardiogram and are transported directly for PPCI. Efforts have primarily focused on improvement of FMC-Device time. SxFMC time is less understood, collected and studied. Our goal was to identify factors that influence STEMI patients’ decision making to employ emergency medical services (EMS) vs self-presenting to an emergency department (ED). Methods: Between 1/1/2013- 12/31/2014, we collected data on 481 consecutive low risk STEMI patients, excluding cardiogenic shock, cardiac arrest and unsuccessful PPCI. Results: The median SxFMC was 53 minutes (interquartile range (IQR) 23-120) in EMS cohort versus 139 minutes (IQR 72-297) in ED group (p&lt;0.001). EMS patients were more often older (median age 64, IQR 56-74 vs 60 IQR 52-68) vs ED, p&lt;0.001. Presenting features such as sex, anterior STEMI, and Killip Class were not statistically different between EMS and ED. Risk factors (RF) for coronary disease including hypertension, dyslipidemia, diabetes, smoking, previous diagnosis of myocardial infarction (MI), previous PCI or coronary artery bypass grafting (CABG) were not statistically different between the groups. There was no difference in time of the day of symptoms onset between the groups. Conclusions: Accordingly, demographic, cardiac risk factors, time of onset of symptoms, location and severity of infarction are not associated with patient decisions to employ EMS. However, older patients were more likely to employ EMS. Further research is required to understand these decision-making processes to develop targeted public awareness interventions that are directed to improve SxFMC in STEMI patients.
Abstract 11578: A Case of Spontaneous Coronary Artery Dissection Masking as Acute Myopericarditis
Authors: Ibrahim Ahmed, ingabire Balinda, Howard Julien
Journal: Circulation (2022)

Introduction: Chest pain is a common reason for emergency room visits. Acute coronary syndrome (ACS) remains a high mortality etiology of chest pain. Spontaneous coronary artery dissection (SCAD) is a rare cause of ACS in the general population, but a relatively common cause of ACS in young women. Case: Patient is a 29-year-old female with history of anxiety and fibroids that presented with chest pain. She described the chest pain as sharp, substernal, non-radiating that lasted for 10 minutes after eating dinner. The pain improved with leaning forward and resolved when lying on her stomach. She had a second episode of chest pain after 2 hours with similar characteristics which lasted 10 minutes. She was 4 months post-partum. She reported having a sore throat 4 days prior to the presentation. Troponin peaked at 0.173. ECG showed diffuse ST-elevation and PR depression in V3-V6 I II III aVF. TTE showed LVEF 65% and no wall motion abnormalities. CTA coronary showed 50-60% narrowing of mid LAD. Cardiac MR showed mild hypokinesis of mid-anteroseptal wall with associated subendocardial to midmyocardial delayed enhancement with focal elevations in myocardial native T1 and T2, and LVEF 53%. Coronary catheterization showed 50-60% stenosis in the mid-LAD distal to the first diagonal artery, there was no improvement in the stenosis after administration of intra-coronary nitroglycerin, there were no septals noted to arise from this area, consistent with diagnosis of SCAD (figure 1). Diagnosis: On initial evaluation, the etiology of her chest pain appeared to be myopericarditis. However, using CTA coronary, cardiac MR and coronary catheterization findings, the pain was more consistent with type 1 NSTEMI in the setting of SCAD. Patient was started on IV heparin, metoprolol tartrate, and aspirin. Conclusions: SCAD is a life-threating and often missed etiology of ACS. It requires a high index of suspicion and should be in the differential diagnosis in young women presenting with chest pain.
Abstract 11923: High Sensitivity C-Reactive Protein is Associated With Vulnerable Characteristics in Coronary Plaques in Patients With Stable Coronary Disease
Authors: Masahiro Katamine, Yoshiyasu Minami, Kiyoshi Asakura, Takako Nagata, Daisuke Kinoshita, Junya Ako
Journal: Circulation (2022)

Introduction: Higher level of high sensitivity C-reactive protein (hsCRP) is associated with an increased risk of cardiovascular events in patients with coronary artery disease (CAD). However, the association between hsCRP and the characteristics of coronary plaques in patients with CAD remains to be elucidated. Hypothesis: Higher hsCRP is associated with a higher prevalence of vulnerable characteristics in coronary plaques in patients with CAD. Methods: A total of 793 consecutive patients with stable coronary disease (SCD), who underwent optical coherence tomography (OCT) imaging of coronary plaques were included. The characteristics of culprit or non-culprit plaque assessed by OCT were compared between the higher hsCRP group (hsCRP ≥ 0.2 mg/dL, n=247) and the lower hsCRP group (hsCRP &lt; 0.2 mg/dL, n=546). Results: In culprit plaques, the prevalence of thin-cap fibroatheroma (TCFA) was significantly higher in the higher hsCRP group than in the lower hsCRP group (23.8% vs. 14.9%, p=0.003) (Panel A). In non-culprit plaques, the prevalence of TCFA (28.6 vs. 18.2%, p=0.014) and plaque with marcophages (56.4 vs. 45.1%, p=0.029) was significantly higher in the higher hsCRP group than in the lower hsCRP group (Panel B). Conclusions: Higher level of hsCRP is associated with a higher prevalence of vulnerable characteristics in culprit and non-culprit plaques in patients with CAD. The present results may partly explain the pathogenesis of an increased incidence of ​recurrent cardiovascular events in patients with CAD.